| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $74.87 | $118.21 | $159.00 | |
Aetna
| Professional | $42.78 | $42.78 | $42.78 | |
Hally Health
| Professional | $55.03 | $55.03 | $150.00 | |
Medica
| Facility | $72.30 | $72.30 | $92.12 | |
Midlands
| Facility | $63.77 | $77.95 | $99.20 | |
Wellmark
| Facility | $44.57 | $44.57 | $44.57 |